{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T16:04:52Z","timestamp":1789488292642,"version":"build-2803163510"},"reference-count":21,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T00:00:00Z","timestamp":1789430400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Surg."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>We reassessed the association between enhanced recovery after surgery (ERAS) adherence and hospital length of stay (LOS) after laparoscopic hysterectomy for benign disease after removing discharge timing from the adherence exposure to eliminate direct mathematical overlap with LOS.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective secondary analysis used routine clinical audit data from 145 adults treated under an ERAS pathway at Nhan Dan Gia Dinh Hospital, Vietnam, during January 2023\u2013June 2024. The previous 15-item audit score was retained descriptively; the primary exposure was a discharge-excluded 14-item score analyzed continuously and as an ordered completion count. Completion count was examined using proportional-odds ordinal logistic regression. LOS was modeled using zero-truncated Poisson regression after comparing Poisson and negative-binomial alternatives. Model-standardized LOS was estimated at five observed completion counts.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Mean discharge-excluded adherence was 81.1%\u2009\u00b1\u20095.6% (11.36\u2009\u00b1\u20090.79 of 14 items), and 144\/145 patients were at or above the historical 70% threshold. In the primary ordinal model, documented chronic comorbidity was associated with lower odds of higher completion category (adjusted odds ratio 0.37, 95% CI 0.18\u20130.76;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.007), but this estimate attenuated when carbohydrate loading was removed from the score (adjusted odds ratio 0.72, 95% CI 0.37\u20131.41;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.337). Mean LOS was 4.2\u2009\u00b1\u20091.9 days, and median LOS was 4 days (IQR 3\u20134). Each 10-percentage-point increase in discharge-excluded adherence was associated with lower expected LOS (adjusted incidence rate ratio 0.79, 95% CI 0.66\u20130.93;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.005), equivalent to an adjusted incidence rate ratio of 0.84 per additional completed item (95% CI 0.75\u20130.95;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.005). At the five observed completion counts of 9, 10, 11, 12, and 13 items, standardized expected LOS was 6.05, 5.12, 4.35, 3.71, and 3.20 days, respectively. In the simultaneous phase-specific model, preoperative and intraoperative adherence were not independently associated with LOS, whereas postoperative adherence excluding discharge was inversely associated with LOS.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Higher discharge-excluded ERAS adherence was associated with shorter hospitalization, but the magnitude of the association was sensitive to influential observations, and the phase-specific signal was confined to postoperative adherence. Because postoperative adherence and recovery overlap in time, causal inference is not warranted.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fsurg.2026.1907048","type":"journal-article","created":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T15:25:46Z","timestamp":1789485946000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Discharge-excluded enhanced recovery after surgery adherence and hospital length of stay after laparoscopic hysterectomy for benign disease: a secondary analysis"],"prefix":"10.3389","volume":"13","author":[{"given":"Chi Thuong","family":"Bui","sequence":"first","affiliation":[{"name":"University of Medicine and Pharmacy at Ho Chi Minh City","place":["Ho Chi Minh City, Vietnam"]},{"name":"Nhan Dan Gia Dinh Hospital","place":["Ho Chi Minh City, Vietnam"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huynh Truc My","family":"Nguyen","sequence":"additional","affiliation":[{"name":"University of Medicine and Pharmacy at Ho Chi Minh City","place":["Ho Chi Minh City, Vietnam"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dinh Nguyen","family":"Pham","sequence":"additional","affiliation":[{"name":"University of Medicine and Pharmacy at Ho Chi Minh City","place":["Ho Chi Minh City, Vietnam"]},{"name":"Children\u2019s Hospital 1","place":["Ho Chi Minh City, Vietnam"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,15]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"CD003677","DOI":"10.1002\/14651858.CD003677.pub6","article-title":"Surgical approach to hysterectomy for benign gynaecological disease","volume":"8","author":"Pickett","year":"2023","journal-title":"Cochrane Database Syst 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